The Long-Term Consequences of the Veterinarian Shortage

Brenda Villatoro knew it was important to get her four-month-old kitten sterilized; all her other pets were. She never expected that this time it would be so hard.

Villatoro, 33, a Los Angeles student who works part-time as a security guard, is low income, so she applied online for one of the city’s no-cost sterilization vouchers. It didn’t go through—wonky website—so she went to the local shelter on her day off. There was an hour-long line, and even if she got the voucher, the clinic wouldn’t guarantee an appointment. She’d have to register (again online) at 6 a.m. for a place on their waitlist, show up at 7 a.m. to check in, and then wait. And hope. (The clinic website warned that getting on the waitlist was “no guarantee of service.”) And stay put: If the clinic texted that they were ready for her pet and she didn’t respond within 10 minutes, she’d lose her place.

For years, “fixing” pets has been so routine in America that 80 percent of owned animals are spayed or neutered. Now, between the perfect storm of Covid-wrought changes and a veterinary shortage that the industry has warned of for years, accessing the surgery has become nearly impossible, particularly for communities that need help most. In mid-September, in a study published in Frontiers in Veterinary Science, researchers from the University of Florida College of Veterinary Medicine and a software developer analyzed clinic data to estimate that in the last two years, around 2.7 million animals did not get sterilization surgery. Those numbers came from analysis of only low-cost clinic data, and the true total may be higher.

“We think we were pretty conservative in estimating the problem,” says Dr. Julie K. Levy, DVM, one of the study’s authors and Fran Marino Distinguished Professor of Shelter Medicine at the University of Florida. “The study doesn’t account for the possible unneutered animals that will have litters that also go on to have litters.” The result, she and her colleagues concluded, is that “conditions are ripe for a reversal of the [pet] population control gains of the past decade.”

The shortage of affordable, accessible spay/neuter surgery is “everywhere,” says Allison Cardona, California State Director of the University of California, Davis Koret Shelter Medicine Program. “Certainly we see it up and down California. Appointments are booked three, even six months in advance.” (Since a puppy can get pregnant at six months of age and a kitten as early as four months, that’s a long time to wait.) The American Society for the Prevention of Cruelty to Animals (ASPCA) runs high volume clinics in four cities that normally perform some 90,000 sterilization surgeries; in 2020, that number was cut in half.

Mobile units that typically go into underserved communities to perform low-cost mass sterilization of dozens of animals at a time have cut back or even eliminated that service. Teri Austin, president of the nonprofit Amanda Foundation, a long-time Los Angeles-area animal rescue that also operates a full-service veterinary practice, says that the foundation’s mobile has been concentrating on helping local shelters which “themselves are short-staffed and backed up with animals that had been adopted and needed to be spayed and neutered before being released.” (A shelter backlog means kennels stay full and crowding increases making animals sick and stressed. When space runs out, some may be euthanized. Right now adoptions are down and intake up, creating a “shelter crisis that is national and widespread,” says Levy.)

Ominous signs of the fallout are easy to find, too. At a recent low-cost vaccination clinic run by a non-profit, nearly all the 183 dogs and 50 cats coming for their shots were still intact—and their owners’ cars held litters of kittens and puppies.

“We are beyond capacity,” Barstow Humane in California’s Mojave Desert implored in a Facebook post, pointing to a group of six-week-old husky mix puppies  “found on the street… Is there any nonprofit rescue that can take them asap?”

The final straw

Covid surely had a hand in this disaster. As the pandemic spread, medical supplies and personal protective equipment used in animal surgery went instead to overwhelmed human hospitals. Some veterinary practices closed because of outbreaks or to prevent them; others scaled back, concentrating on emergency and life-saving care. The mass surgeries done at mobile and community clinics require vets and veterinary technicians to work together in enclosed, close quarters; Covid made that too dangerous. And veterinary staff were among the many workers prompted to re-evaluate life by the pandemic. A number of veterinarians “decided to retire early or, because they wanted more flexibility in their schedules, chose to work part time, per diem, or in non-traditional shifts that would give them more time with their families,” says Dr. Carolyn Brown, DVM, the ASPCA’s Vice President of Medicine for Community Medicine.

But Covid didn’t cause the current problem as much as it was a last straw. The math is straightforward: More and more American households have pets but there are fewer and fewer working vets to care for them. Boomers are retiring, and only 33 accredited veterinary programs are turning out replacements. In 2021, there were more than 18 available openings for every vet looking for a job. A similar shortage exists for licensed veterinary technicians, the vet world’s indispensable nurse-equivalents who (among other things) help with exams, assist with surgeries, run lab tests, and prepare blood and tissue samples.

Both these shortages have multiple, overlapping causes. Economics is one: According to one study of the veterinary profession, since 2008 the cost of getting a doctor of veterinary medicine (DVM) degree has skyrocketed, and between 2001 and 2017 the growth in veterinarians’ student debt (typically around $183,000) vastly outpaced growth in salaries. Half of vets make less than $100,000 a year. Vet techs fare far worse, earning a mean hourly wage of just over $18. Being a vet tech requires skill, patience, and willingness to put in long hours, but “the pay overall has been abysmal,” says Levy. “If you can earn more at Target, you’re going to work at Target.” Gender is another factor. The veterinary industry is now overwhelmingly female and of child-bearing and child-raising age. The pandemic drove many mothers out of work—and as of August, 2022, there were 427,000 fewer women in the labor force than there were in February 2020. Struggles to find affordable childcare and reluctance to work 60 hours a week with on-call nights and weekends have driven vets to take time off or work only part time. “That the actual number of vets we have is fewer than what we need is exacerbated by the fact that many in the workforce are not employed full time from the time they graduate to the time they retire,” says Brown.

Finally, and most problematically, there’s an issue of work culture. For some years, private equity-funded corporations have been buying out thousands of small veterinary practices and now own a sizable and growing percentage of the market. These “corporate clinics” often offer higher salaries than independents and non-profits, but many pay vets on a base-salary-plus-commission rate. That can create pressure on vets to see a prescribed number of patients per hour and to order tests and push lucrative “extras,” like special diets and supplements. Vets’ income hasn’t increased, but the cost of vet care has. The higher cost means vets face angry clients as well as some who decline service because they can’t afford it—even to the point of what vets call “economic euthanasia.” The American Veterinary Medical Association’s 2020 Census of Veterinarians survey found levels of stress and burnout at record high levels, and that a “lack of work-life balance” was driving almost 40 percent to consider leaving the profession. Or worse: high levels of suicide among veterinarians has been a problem for years.

An uncertain future

As Covid rates decline, there are scattered signs of improvement to the spay/neuter shortage. In 2021, the ASPCA’s surgery numbers rose to 63,000. Austin says that her organization’s mobile units are resuming service.
But most in the industry are hard-pressed to find a happy ending to the story. “Nobody knows what to expect,” says Levy. “We’ve never been in this situation before, and from the trends I’m seeing, we haven’t hit bottom yet. It’s particularly worrisome when it comes to community cats. There are no barriers to their breeding, and we’ve been downsized for three kitten seasons. We know that most kittens born to free-roaming cats don’t survive, so there’s terrible suffering involved.”

Short-term solutions being proposed include what Levy calls a “risk assessment” approach, that is, prioritizing available surgery slots for the most vulnerable animals: “Females, because they’re the ones that reproduce. Then community cats—and the good news is they’re easy and fast—and then the animals that end up a problem in shelters, medium and large-breed dogs.”

“Some [in the industry] are talking about sponsoring veterinarians from other countries,” says Cardona. More controversial is the idea being floated that shelters may have to allow animals to be adopted intact, trusting new owners to prevent breeding and get their pets sterilization surgery whenever they can.
Cardona, Brown, and Levy all emphasize that the public can help shelters now by adopting, fostering, or taking a pet for a one-day shelter vacation. Anything to ease the crowding. “You can also contact local subsidized clinics and just ask what they need,” says Levy. “It might be money, sponsoring surgery for someone who can’t afford it, or volunteering time to work with the animals, help with social media, or driving animals to a clinic for people who don’t have access to transportation.”

The much harder fix will be growing and stabilizing the vet profession to avoid the nightmare scenario suggested in a study by Banfield Pet Hospital (a corporate owner of veterinary clinics): By 2030, 75 million pets might be without access to vet care.

Encouragingly, says Brown, the long-static number of vet programs is increasing, and both shelter medicine and working in underserved communities have become desirable career tracks. Still, it’ll be years before we see significant numbers of new graduates. So also needed are structural changes in the practice of veterinary medicine: Better pay and more respect for vet techs. More flexibility for vets, including parent-friendly hours and leave policies. Another option: establishing what Levy calls “boot camp training programs” for vets who might be interested in doing high-volume sterilization work rather than seeing individual clients. (Alas, no one believes that the corporate takeover of vet practices will slow.)

Brenda Villatoro was lucky enough to run into a representative from a local nonprofit who used her contacts to get her a spay voucher and an appointment for her kitten.  As it should be. Years before the advent of the “no kill” movement, widespread pet sterilization drastically reduced shelter euthanasia. In the last 20 years, that progress has continued. “We’ve seen the human-animal bond strengthen in all kinds of communities,” says Austin. “Fewer animals tied up in the yard, education about spay and neuter growing by leaps and bounds, fewer people who talk about breeding.”

No one wants to go backward.